“Baby, it’s Cold Outside!”

Many Injured Workers who are exposed to Cold on the job. Cold Exposure can be a source of work injuries. Cold Exposure can take many forms. Cold Exposure can be the result of outdoor work as well as indoor work. Cold Exposure can be the result of cold weather.

Cold Exposure can be the result of working in a refrigerated work environment. Cold Exposure can be the result of working in an environment for which there is an air conditioning system. Work Environments that have poor insulation or lack of a heating system for workers also expose workers to cold.

Work-Related Cold Exposure Injuries can entitle workers to obtain medical treatment for these medical conditions and obtain workers’ compensation benefits.

This article will discuss Cold Exposure and Cold-Related Medical Conditions. Further, case law concerning cold-related injuries will be discussed.


How Cold is Cold?

A Cold Environment is one that is near-freezing temperatures. This is considered “Extreme Cold.” A Cold Environment causes the body to work harder to maintain its temperature. Both Cold and Wind Chill can impact the degree of coldness.

Extreme Cold can drive down the skin and the internal temperature of the body. This is what is known as the core temperature. Extreme Cold can cause the body to shift blood flow from the extremities and outer skin of the core. When this occurs, it can lead to serious health problems, tissue damage, and death.

According to the American Conference of Governmental Industrial Hygienists (ACGIH®) Threshold Limit Values (TLV®), workers should be protected from exposure to cold so that the deep core temperature does not fall below 96.8°F (36°C) and to prevent frostbite to body extremities [ACGIH 2019]. DHH(NIOSH) Publication Number 2019-113


Are there Risk Factors When Dealing with Cold Exposure?

Yes. There are some risk factors that make for a greater chance of injury when exposed to cold. These risk factors include wetness, dampness, being improperly dressed as well as exhaustion.

These risk factors can also include workers who have pre-existing health conditions such as hypertension, hypothyroidism, and diabetes. Also, a worker with poor physical conditioning is also at risk.


What Types of Occupations are at Risk for Cold Exposure?

There are a variety of workers who are at risk for cold-exposure related injuries. These occupations include Snow Cleanup Crews, Sanitation Workers, Police Officers, and Emergency Response Personnel such as Firefighters and Emergency Medical Technicians.

Further, other occupations include an individual who works in refrigerated areas or manufacturing facilities that require cold temperatures. Additionally, Long Haul Truck Drivers are at risk for cold exposure.


Was are Cold-Related Medical Conditions?

Cold-Related Medical Conditions include Chiliblains, Trenchfoot aka Immersion Foot, Frostbite, and Hypothermia.

Besides Cold-Related conditions, Cold Exposure can also have an impact on other medical conditions. Cold-related conditions aggravate a Worker’s pre-existing musculoskeletal injuries and vascular disorders.


What is Chiliblains?

“Chilblains are the painful inflammation of small blood vessels in the skin that occur in response to repeated exposure to cold but nonfreezing temperatures. Small blood vessels in the skin may become permanently damaged by cold temperatures, resulting in redness and itching during additional exposures.

Symptoms of chilblains include redness, itching, possible blistering, inflammation, and possible ulceration in severe cases..” DHH(NIOSH) Publication Number 2019-113.


What is Trendfoot aka Immersion Foot?

“Trench foot is an injury of the feet after prolonged exposure to wet and cold-related conditions. Trench foot occurs because wet feet lose heat faster than dry feet. To prevent heat loss, the body constricts blood vessels in the feet, and then the skin tissue begins to die.

Symptoms of trench foot include reddening of the skin, numbness, leg cramps, swelling, tingling pain, blisters or ulcers, bleeding under the skin, and gangrene (e.g., foot turns purple, blue, or gray).” DHH(NIOSH) Publication Number 2019-113

This condition can occur at temperatures as high as 60°F


What is Frostbite?

“Frostbite is an injury caused by freezing of the skin and deeper tissues, resulting in the loss of feeling and color in the affected areas. Frostbite can permanently damage body tissues, and severe cases can lead to amputation.

Examples of risk factors for frostbite include contact with metal or water, dehydration, diabetes, smoking, alcohol abuse, sedating or judgment impairing medications, and prior history of frostbite. Symptoms of frostbite include numbness; tingling or stinging; aching; and bluish or pale, waxy skin.” DHH(NIOSH) Publication Number 2019-113.


What is Hypothermia?

Hypothermia is another cold-related illness. “[w]hen exposed to cold temperatures, the body loses heat faster than it can be produced. Prolonged exposure to cold causes internal body temperature to drop, resulting in a condition called hypothermia. Hypothermia affects brain function, making the victim unable to think clearly or move well (i.e., they may be unable to protect themselves from hazards, or experience slips, trips, and falls). This makes hypothermia particularly dangerous because a person may not recognize the symptoms and will be unable to make life-preserving decisions.

Symptoms of hypothermia can depend on how long a person has been exposed to cold temperatures and individual variability. Hypothermia Symptoms and First Aid Early symptoms include shivering, fatigue, loss of coordination, confusion, and/or disorientation. Late symptoms include no shivering, blue skin, dilated pupils, slowed pulse and breathing, and/or loss of consciousness. If hypothermia is suspected, medical assistance should be requested immediately (e.g., call 911).” DHH(NIOSH) Publication Number 2019-113.

Hypothermia occurs when the normal body temperature of 98.6 degrees drops to less than 95 degrees. It can occur even at cool temperatures above 40 degrees.


Has there been Caselaw concerning Cold Exposure?

Yes. There have been several cases of interest concerning Cold Exposure.

Nature and Extent of Cold Exposure: In a case involving a partial lower extremity amputation, the applicant claimed cold exposure as a causative element that caused the necessity for the amputation to be required. The Court of Appeal discussed the fact that there was an issue concerning the duration and degree of cold exposure.

In sum, the applicant and applicant’s medical evidence was not found to be convincing as to bring it to the level of substantial evidence on the issue. The applicant’s claim was not found to be industrial. Cigna vs. WCAB (1996) 61 Cal. Comp. Cases 1378.

The take away from the case is that evidence of nature, i.e. the temperature and elements exposed to, and the amount of time of the exposure are important facts that the Injured Worker should obtain in order to prove up their case.

Exposure to Cold Aggravating Pre-Existing Medical Conditions: In this case, applicant claimed that her exposure to cold air in her employment aggravated her underlying bronchial disease and caused chronic pulmonary disease. Applicant prevailed. Aetna vs. WCAB (1976) 41 C.C.C. 252.


Can Cold Injuries Be Prevented?

Yes. There are countless efforts that Employers and Workers can take to reduce the risk of cold-related illness and injury.

Prevention measures include planning, education, reducing cold exposure, allowance for breaks to be in heated environments, proper clothing and the allowance for changing out wet clothing. There are many additional measures that can be taken to prevent cold-related injury.


What If I Need Advice?

If you would like a free consultation regarding your workers’ compensation claim, or if you feel you have medical mismanagement claims, please contact the Law Offices of Edward J. Singer, A Professional Law Corporation.

They have been helping people in Central and Southern California deal with their workers’ compensation cases for 26 years. Contact us today for more information.


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